AB1674 TOWARDS A GUIDE FOR EVIDENCE-BASED TELEMONITORING: SENSITIVITY OF PATIENT REPORTED OUTCOMES TO CHANGE IN DISEASE ACTIVITY STATUS IN EARLY AND ESTABLISHED RHEUMATOID ARTHRITIS
Authors: A. Looijen, E. Van Mulligen, A. Van der Helm – van Mil, P. De Jong
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In the treatment and follow up of rheumatoid arthritis (RA) patients, it has become more desirable to detect changes in disease activity through telemonitoring, for which patient reported outcomes (PROs) might be useful. So far associations between PROs and changes in disease activity have been mostly investigated on a continuous scale. However, in daily practice and in line with the EULAR recommendations, treatment decisions are mainly based on the patient's disease activity status. Earlier literature has shown that functionality, joint pain, morning stiffness, general health (GH), health-related quality of life and fatigue change with the development and resolution of a disease flare. <h3>Objectives</h3> Therefore, our aim is to determine if PROs that cover functionality, joint pain, morning stiffness, health-related quality of life and fatigue are sensitive to disease activity status alterations (from active to low disease activity to remission, and vice versa) in patients with early and established RA. <h3>Methods</h3> Early RA patients from the tREACH-trial and established RA patients from the TARA-trial were included. Both studies were multicentre, single blinded trials with a treat-to-target design. Treatment alterations were based on the disease activity score (DAS44) and PROs were collected at 3-montly fixed intervals. The following PROs were studied: (1) the Health Assessment Questionnaire Disability Index (HAQ-DI), (2) joint pain (numeric rating scale, NRS 0-10), (3) morning stiffness severity (NRS 0-10), (4) GH (visual analogue scale, VAS 0-100mm), (5) health-related quality of life (EQ-5D) and (6) fatigue (VAS 0-100mm). Disease activity statuses were defined as: (1) active disease (DAS≥2.4), (2) low disease activity (LDA, DAS&lt;2.4 and ≥1.6) and (3) remission (DAS&lt;1.6). Differences in disease activity status between two consecutive visits were compared to changes in PROs. Mean changes in PROs per disease activity status alteration were compared to stable disease activity status, using generalized estimated equation-models. <h3>Results</h3> Respectively 587 and 189 early and established RA patients were included. The median symptom duration (IQR) was 0.4 (0.2-1.8) and 6.2 (4.1-8.9) years, respectively. The mean DAS (95%CI) at baseline was 3.0 (3.0-3.1) in the early and 1.0 (0.9-1.1) in the established RA group. <b>Figure 1</b> shows the mean change (with 95%CI and significance) in PROs per change in disease activity status. HAQ-DI, joint pain, morning stiffness, GH, EQ-5D and fatigue (in early RA) were in concordance with improvement or worsening of disease activity status. Change from active disease to LDA or vice versa had a larger effect on HAQ-DI, GH, and EQ-5D compared to change from and to remission to LDA. Respectively, change in HAQ-DI was 1.9 and 1.8 times greater going from active disease to LDA compared to a shift from LDA to remission and vice versa. For GH this was 1.6 and 1.2 and for EQ-5D 2.1 and 2.0 respectively. <h3>Conclusion</h3> Changes in HAQ-DI, morning stiffness, joint pain, GH and EQ-5D correspond to changes in disease activity status. These results suggest that changes in aforementioned PROs may be helpful in telemonitoring of RA. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.